Benign Essential Tremor

Question 1

What is it?

Answer 1

Benign essential tremor is a relatively common condition associated with older age. It is characterised by a fine tremor affecting all the voluntary muscles. It is most notable in the hands but affects many other areas, for example causing a head tremor, jaw tremor and vocal tremor.

Question 2

Features

Answer 2

Fine tremor
Symmetrical
More prominent on voluntary movement
Worse when tired, stressed or after caffeine
Improved by alcohol
Absent during sleep

Question 3

Differential Diagnosis of Tremor

Answer 3

Benign essential tremor is diagnosed clinically based on the presenting features. It is important to look for features to exclude other causes of a tremor.

The key differential diagnoses of a tremor are:

Parkinson’s disease
Multiple sclerosis
Huntington’s Chorea
Hyperthyroidism
Fever
Medications (e.g. antipsychotics)

Question 4

Management

Answer 4

There is no definitive treatment for benign essential tremor. The tremor is not harmful and does not require treatment if not causing functional or psychological problems.

Medications that can be tried to improve symptoms are:

Propranolol (a non-selective beta blocker)
Primidone (a barbiturate anti-epileptic medication)